Provider First Line Business Practice Location Address:
86 OP MED READINESS SQ
Provider Second Line Business Practice Location Address:
MENTAL HEALTH OSC-SGXW
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
496-371-4614
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/27/2006